title: Derivation and validation of a mortality-risk index from a cohort of frail elderly patients hospitalised in medical wards via emergencies: the SAFES study.
abstract: To identify predictive factors for 2-year mortality in frail elderly patients after acute hospitalisation, and from these to derive and validate a Mortality Risk Index (MRI). A prospective cohort of elderly patients was set up in nine teaching hospitals. This cohort was randomly split up into a derivation cohort (DC) of 870 subjects and a validation cohort (VC) of 436 subjects. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 2-year mortality and to identify risk groups for mortality. A ROC analysis was performed to explore the validity of the MRI. Five factors were identified and weighted using hazard ratios to construct the MRI: age 85 or over (1 point), dependence for the ADL (1 point), delirium (2 points), malnutrition risk (2 points), and co-morbidity level (2 points for medium level, 3 points for high level). Three risk groups were identified according to the MRI. Mortality rates increased significantly across risk groups in both cohorts. In the DC, mortality rates were: 20.8% in the low-risk group, 49.6% in the medium-risk group, and 62.1% in the high-risk group. In the VC, mortality rates were respectively 21.7, 48.5, and 65.4%. The area under the ROC curve for overall score was statistically the same in the DC (0.72) as in the VC (0.71). The proposed MRI appears as a simple and easy-to-use tool developed from relevant geriatric variables. Its accuracy is good and the validation procedure gives a good stability of results.
authors.affiliation: Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: M
authors.initials: M
authors.lastname: Dramé
authors.forename: J L
authors.initials: JL
authors.lastname: Novella
authors.forename: P O
authors.initials: PO
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Somme
authors.forename: N
authors.initials: N
authors.lastname: Jovenin
authors.forename: I
authors.initials: I
authors.lastname: Lanièce
authors.forename: P
authors.initials: P
authors.lastname: Couturier
authors.forename: D
authors.initials: D
authors.lastname: Heitz
authors.forename: J B
authors.initials: JB
authors.lastname: Gauvain
authors.forename: T
authors.initials: T
authors.lastname: Voisin
authors.forename: B
authors.initials: B
authors.lastname: De Wazières
authors.forename: R
authors.initials: R
authors.lastname: Gonthier
authors.forename: J
authors.initials: J
authors.lastname: Ankri
authors.forename: C
authors.initials: C
authors.lastname: Jeandel
authors.forename: O
authors.initials: O
authors.lastname: Saint-Jean
authors.forename: F
authors.initials: F
authors.lastname: Blanchard
authors.forename: D
authors.initials: D
authors.lastname: Jolly
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods*; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index